What is "Fire Culture" Anyways?

I have had a tonne of discussions with various people in the fire service. From firefighters to chiefs, across the entire spectrum and something strikes me as odd. We discuss the “culture” of the first service, and, I think, we always know what the other means. But, take the idea just a step further. Describe fire culture.

Gets tough, doesn’t it?

Well, in regard to mental wellness we seem to want to promote fire culture as maintaining a type of invisible barrier toward making progress. Fire Culture, we say, needs to “catch up”, or “well it’s the culture of the fire service that makes implementing these things difficult”. And then I go on to speak with the chief who is forward-thinking and supportive, and then the deputy, and the firefighters on the ground seem to support it as well, and I start to become confused with where this cultural barrier even lies.

Culture seems to always be considered the barrier. *Retrieved August 10th, 2017 from https://pixabay.com/p-2309816/?no_redirect

Culture seems to always be considered the barrier.
*Retrieved August 10th, 2017 from https://pixabay.com/p-2309816/?no_redirect

But, the issue may lie more in our wish to both accept that mental wellness is a concern but also distance ourselves from it. Obviously, it becomes very difficult to make any blanket statements that would stick, and each department will invariably have its nuances and issues, but as far as I can tell from speaking with people, this is where I land.

We want to be supportive from a distance. Or, as a friend has said to me, we want “awareness” because that means the work is someone else’s problem. Just like being hazmat awareness level means we know just enough to think that the chemical is both scary and that we are ill-equipped to handle it.

And then, we call someone else.

Now, I have never endeavored to create firefighting therapists. And, I will never suggest that this is what we need. Indeed, creating partnerships with local mental health agencies and getting those folks familiar with each other is a likely way toward moving to a more accepting attitude toward mental wellness. With continuing to suggest, however, that simply having access to an EAP is enough, management may inadvertently promote the idea that they do not take seriously the issue at hand. From those that I have engaged with, however, I hear that they wish they knew more. That they understood more. That they were given a clear understanding of the issues that can affect them and what they can do to support each other.

This is the key to overcoming “fire cultural” barriers.

By allowing and supporting those on the front line to engage in mental wellness training just enough to ensure that they are effective for their peers. After all, the research is showing that peer-to-peer work is often the most accepted and most effective at overcoming mental wellness adversity. The culture, again we are told, has an issue with “outsiders”.

This is likely the most obvious barrier towards accepting help. And yet, this we consider part of the fire culture but is more likely an issue with human beings more generally. We don’t wish to accept that we might have a mental wellness concern. We continue to propagate the idea that having a mental health issue is somehow a weakness of character. This is exaggerated within the fire service because on the baseline we have this idea of the “hero”. Now, individually we may have issues with this, but simply google firefighter in the images and you can get an idea of the baseline cultural view. With flames, explosions, and armed with axes, the hero image is difficult to deny as solidified. And, what runs counter to this image is the opposing cultural view that mental wellness is a weakness.

Screenshot of a google search images for "firefighter" - A instance of the "culture" ?

Screenshot of a google search images for "firefighter" - A instance of the "culture" ?

We can hear this echoed by those from older generations. And of course, we still have these hardened ideas sprouting from newer members. This idea of mental wellness as a weakness could be considered the resulting cultural view of an entire organization when no overt messaging for the opposing view is available. Therefore, staying silent, in effect, supports the idea. We know, or at least ought to know, that mental wellness issues within a career of trauma are inevitable. Note, however, that I am not suggesting that we will develop mental health issues.

Indeed, by taking the issues of mental wellness seriously, we can mitigate many of the contributing factors that later lead to the very mental wellness issues we wish to avoid. This is an unfortunate irony.

Well, we now have a bit of a better grasp on what fire culture might be. The development of a cultural idea is both external (the beliefs and ideas that the public gives to us) and internal (the ideas and beliefs that the organization holds). And, when we discuss fire culture as being a barrier, we can at least look to see if what we mean is that we—yes, we—wish to avoid having the responsibility of helping others based on the injury.

So, then what can we do about it?

Well, provide a check-in organizationally. What is the messaging that you may be sending unconsciously? When asked or offered to go above and beyond simply having “bread and water” mental wellness interventions, do you suggest that operational costs are too high to consider it? Or, perhaps the most egregious, do you believe that this isn’t an issue for your department? We have a natural propensity towards blaming and wishing to pass the onerous onto others. We wish to label it a result of stigma, or of management, or of whatever other issues there are. But, we fail to recognize that we can create a powerful subculture.

Are you serving up "Bread and Water" interventions in your organizations?

Are you serving up "Bread and Water" interventions in your organizations?

This subculture is one of mental wellness acceptance and an understanding of the seriousness. One that takes the mental wellbeing of our brothers and sisters the same as those of physical wellbeing. When someone falls, we offer almost reflexively to pick them up. We can create a subculture of being able to respond similarly to mental wellness falls as well. After all, it is more likely that we will experience a mental wellness issue in our lives, so why not help now and develop the network of those who can help us later when we may need it.

Creating, if needed, a grassroots subculture allows the conversations around mental wellness to be had. And talking about them is the number one best thing we can do to trying to eliminate the stigma around it. Once it becomes everyday parlance, then it becomes an excruciatingly simple process to begin to spill the subcultural effects into the larger fire culture.

The hard part? Being the one who wishes to be more than just Mental Wellness Aware. Instead, being a proponent for mental wellness. Being one who will suggest first that a call has bothered you. But, remembering that you are most certainly not alone in this and that by stepping up. Others will certainly follow.

With a bit of hesitation...

One of the worst things I have had to do within my educational career was to record sessions and have them critiqued by my clinical supervisor... seriously, the worst.

Well, despite the negative impact this has had on me (and I exaggerated said impact) I'm stepping out of the comfort zone and posting this!

It was filmed at the Badge of Life conference in London on June 8th, 2017.

Happy watching

https://www.youtube.com/watch?v=tH7CuDbPdlc

Gracious Donation!

The battle for First Responder mental health can feel like a daunting one... That is, until you get into a room with both Badge of Life and Ivegotyourback... then it can feel like there is nothing left to do!

But, the reality is that there is A LOT left to do. And, there some are backing us in the battle to become stigma-crushing, change ninjas!

I need to send a massive thank you to, Don King, Bill Sparfel, and the rest of the SafeDesign Apparel team in Etobicoke! They have generously donated a Globe Bunker Jacket for me to represent Fire; the service that kicked off this mental wellness journey for me.

It's an honor to have received this. And, I dare say that it fits damn well too :)

http://www.safedesign.com/

Stay safe,

Nick Halmasy

Stigma

STIGMA

scary-dog.jpg

If depression was a “black dog”, I wonder what could be made of anxiety, addiction, or PTSD? And, that is still ignoring the larger issues that first responders can suffer from. This includes, as is usually excluded, our friends in dispatch and corrections. I feel that if labelling just one of the disorders in this haunting image of shadows and teeth, I can only think to try and capture all the disorders would take some mythological knowledge. That, I do not have and leave it to smarter people to identify. But, if we are going to have any control at all, then we would need a leash.

That leash is the abolishment of stigma.

Removing the very “scary” notion that these disorders are the result of us being “wired wrong” or “different” from others is a mandatory step. We fear what we don’t know; but, we might be more fearful of what we think we know. And if we get our ideas of mental health from movies, surely we have a right to be afraid. After all, we tend to characterize violent criminals as “insane” and quickly label them as “having a screw loose”. We do this to distance ourselves from the very real idea that someone “normal” could produce such horrific, violent actions. But, if we were to learn anything from Milgrim or Zimbardo, we know that given the right circumstances, we, too could commit horrific acts.

Stigma allows us to create that distance. A psychological fence for which the Black dog, or beast, or whatever we want to identify it as metaphorically, is separated from us. I see this almost every day. Those who finally reach out for help sit quietly, head down, waiting for their appointment. They wear shame and guilt upon their face as if they deserve whatever punishment that they are experiencing. They might be 6 feet tall, but many of them, when they sit in the chair, occupy less space than small children. The stigma of their experience has pounded and gnashed their very spirits into nothingness. They sit a pool of emotional confusion and utter psychological torture. They embody the dog behind the fence. And they see all the “normal people” as outside and think to themselves that the grass seems always greener. Why can’t I be like them? Why can’t I be like I was?

Part of my role, and any therapist’s role, is to re-establish emotional connectivity and normalize their experiences. Indeed, this may seem very odd given that they struggle to get out of bed, they cut, they have actively attempted to die by suicide, and maybe often ushered to the hospital in a flurry of overdoses and other psychological and physiological concerns. How, I see in their eyes, can you call this normal? The stigma weighs them down.

It is a therapist job to create a leash. Because we need to walk this dog a while before we learn to let it go and move on. But, what of the ground for which the dog occupies? Well, that is the environment that they are in. Having spent 10 years in the fire service, I’ve felt this “us versus them” within the first responder environment.

Too many times have I read that “if you can’t cut it, cut out”. This damning and damaging adage does nothing but exaggerate the emotional confusion of their companions. And, of course, it is completely and utterly untrue. It is absurd. So, the argument can be extended, if an electrician develops anxiety then she is no good for the job? If the secretary develops depression, he is then doomed to seek other employment? The absurdity of the idea is seen clearly, when that argument is applied to its fullest.

And, the above jobs are thought to experience traumatic events rather rarely; however, the argument then suggests that even though the traumatic exposure is increased for first responders, one is held to an ever-higher standard of mental resiliency. This does nothing but continue the idea that first responders are more than human. This is the crackpot elitism that needs to be swiftly removed from the service’s philosophy. With this idea gone, we can more easily operate on the removing of stigma from the services.

There is an check for whether stigma is present in the workplace. After returning from a call, pay attention during the standard round table. Listen for if people talk about how they might have felt helpless, or hopeless, or perhaps that this call “bugged” them a bit. It is safe to say that this is on the way to developing a stigma-free workplace. Clearly, they remain comfortable and feel supported in that environment. But, as is too often the case, if “I’m fine” works its way around the table, there is work to be done. This is the most common response. Of course, that means that the facilitator of the debrief needs to change the questions; but, be cautious. If the administration remains philosophically unchanged, no amount of diverse questioning will make the crew feel safe enough to step up.

Stigma is crushing the services.

This may seem counter-intuitive to what we have been witnessing in the media with the flurry of news uncovering PTSD in First Responders. But, this is just an iceberg. What means while it is finally being admitted that there are real mental health injuries that can be the result of work within the field, we are ignoring all the mental health concerns that also affect us. We are only looking at the small piece sticking out of the water. Soon, we will realize that a more holistic outlook is needed. Mental Health is as important as physical health. We need to recognize it as such. Let’s leash the beast and take it for a walk.

The Calls That Stick

** Potential Trigger Warning**

Anyone in the service for longer a year has a story to share. These are usually quick to come to mind. There are the ones where we all laugh, usually at the expense of fellow First Responders. Or, there are the calls where the scene was a mess and yet no one was hurt. We happily relive, retell, and may even embellish these events.

But, those are not the only calls that stick.

freeimages.com

freeimages.com

Why we were there was anyone’s guess. But, there we were. And so too were our friends in Police and EMS. The train conductor was also there. I remember reaching for the handle on the small ladder at the side of one of the rail cars, and lifting myself up and over to the other side. Preparing, as best as I knew how (which was not at all), for the scene that I was about to see. Looking down at the ground, as if to prolong the time before I needed to shift my attention to the body; then, I remember stepping over the foot.

The rest of the call was relatively uneventful, as far as scenes are concerned. We spent most of the time doing our best to find humour to take the weight of the scene off each other’s backs. What a weight to lift. We’d laugh, if not from the pressure, than at least by proxy. We were all trying our best. It was early morning, so for many of us the day had just begun. We would be expected to continue to attend to other scenes, calls and duties.

freeimages.com

freeimages.com

What came next were the sleepless nights. Nightmares, restlessness and some insomnia were secondary to the disturbing thoughts that seemed to come from nowhere. Even as I write this I am seeing the scenes and remembering the feelings. The understanding is there now, but I had no idea what was happening to me during that period. The body and mind were working hard to understand, to make sense, of what I had seen.

The funny thing about the calls that shake us is that they also shape us. At least, it shaped me. There isn’t a day that I cross the railway, or open the door to a frozen world, where I am not reminded of that call. I never cross a railway without that “feeling” coming back, at least in some small way. As I cross the tracks, I look down at the rails almost expecting to see what I saw that day. That “feeling” that we get is not unnoticed by the researchers in the field. There are some well-known psychologists and psychiatrists who now argue that it is not just the mind that remembers, but also the body. This makes the process that more complex and a little more difficult to understand how to overcome it.

There was another person with us that day, too. The conductor. What got me the most was not his calm composition, though it was impressive. What impressed me the most was the process in place following that incident for him. The train would remain where it was until a relief conductor had arrived. Then our friend would be taken home and was given a period of time, paid, off work. Following that, and checking in with a mental health specialist, he would then be able to return to work.

Certainly, these events were not as rare as we would like to think. In the decade I spent serving my community, I had only attended one scene where someone died by train. But, for the conductor, he had already experienced multiple incidents like that.

But, as I reflect I am appalled.

A train company, a company used for hauling and moving product, had a better response plan than the first responders. First Responders who would see more horrific, more emotionally charged, and more intense scenes were left, largely, to themselves to deal with their struggle.

While the winds are certainly changing, it is difficult to feel that change on the working end. The pioneers of Critical Incident response, Mitchell and Everly, have had articles and papers out since the 80s. Their manual, which was the breakthrough text for First Responders and Critical Incident Stress, was released in the 90s! And yet, in 2016, we are still scratching our heads as to why folks are quitting, taking sick leave, and retiring early.

I fought fires the same way in 2006 as I did in 2016. Only during the later years of that short career did we begin to hear of change. Research had been out for years, but something finally had clicked. Understanding that the nature of fires had changed, did little for administrations to commit to a new approach. This resistance that seems to remain in the firefighting world, I think, plays a large part into the integration of appropriate mental health concerns.

I didn’t know what was happening to me back on that cold day. I didn’t know what was happening to me during the following weeks. I was lucky, however, as I was able to talk with someone who understood. But, I now understand how that scene really impacted me and how I took many things with me that will stay with me. That scene stuck. I certainly wasn’t alone there either, but as the “super hero” mentality is still strong in this field, no one said anything.

This is exactly where change can occur. We can continue to stand, chin-up, look around the room and echo, “I’m fine”, like our brothers and sisters before us. You can bury the problem underneath the fear and stigma that a mental health problem is something to be ashamed of, something that shows that you’re flawed. Or, you can stand, chin-up, and do the real “heroic” thing. When a scene is “stuck with you”, name it. It will be to the relief of the few who, like you, are just trying to understand something that they have never experienced before.

Over the years, my experiences have warped and torn my memory, reducing them to postcard-like snapshots. Some of the details are hard to trust, while others have forever etched themselves onto my brain when I recall them. What is important is to try and remember what you are able to learn from each of the calls, not simply remember what you saw. Each incident is a chance to grow not just skilfully, but also psychologically. We are able, and research shows, to experience Post-Traumatic Growth.

freeimages.com

freeimages.com

Stress and Disease

Stress. Something we often think about, deal with, then move on. While there can be a lot said about "Eustress" aka. "good stress", when it comes to first responders we rarely mean "good" stress. The overwhelming amount of negative stress that First Responders experience has lead to the national recognition that Post Traumatic Stress Disorder as a "workplace hazard". We have heard about PTSD often in the media (and it has been spoken to on this site, and many others). What we hear about are the immediate impacts of this disorder; however, if those effects weren't horrific enough, there is some shocking research suggesting the impacts might be much further reaching!

As research progresses, we are growing to find that the mind and body are connected. This may seem intuitive, but this has been debated for years between psychologists and philosophers alike. It is a psychological paradigm shift to have therapists now paying attention to how the body is reacting to different issues from depression, to anxiety, to trauma. What is more, is that this is rarely something that First Responders are oriented to pay attention to, let alone spend any time considering.

In a discussion with Dr. Andy Brown, he asked me to reflect on a moderately stressful call. "Focus on an event, not one that was very traumatic, but one that was a little bit stressful". Once I had one in mind, Dr. Brown led me through a "Body-Scan", identifying areas that were strained, sore, or otherwise abnormal. While this experience was void of the typical clinical approach or atmosphere (you can only get so much of that via phone), I was still able to find areas in my body that seem to be triggered when I recalled the event. This is not to say that I, or you, have PTSD, but rather that the traumatic calls and stress from them can be "remembered" by our bodies. Dr. Brown hypothesized that trauma gets "stuck" in the body. If this is left long enough without intervention, the body may turn these experiences into pain.

This is the basis behind a lot of the newer research, especially that of psychiatrist Bessel van der Kolk. His book, "The Body Keeps Score" culminates his journey in psychiatry that had led him to uncover the importance of the body in understanding trauma. " Not the emotions such as anger, anxiety or fear", Bessel writes, "but the physical sensations beneath the emotions: pressure, heat, muscular tension, tingling, caving in, feeling hollow and so on".

The research is becoming quite clear on the impact that this disconnection between mind and body can have. From the relatively basic and somewhat harmless concern or attempt to supress a thought, which ironically increases the desire and obsession of the very thoughts we want to avoid (Baird, Smallwood, Fishman, Mrazek, & Schooler, 2013), to the severe and significant impact of “Alcohol dependency… considered a dissociative reaction of individuals with difficulties in identifying, expressing, and regulating emotions” (Craparo, Ardino, Gori, & Caretti, 2014).

But, studies are beginning to link a connection between the effects of on-going stress and the development of dementia. Quershi and colleagues made this link when looking at Veterans with PTSD (2010). Alarming was the finding that those with a PTSD diagnosis were twice as likely to develop dementia. This was a similar conclusion of researchers Maziab and colleagues whom found comparable results with their work with Veterans and POWs (2014).

And, while all these studies are not specifically looking at First Responders, I assume it is only a matter of time before the link is made within the ranks. While the severity and frequency of those events experienced by our military friends is significant, the accumulated experiences by First Responders can add up as well. And, of course, in some extreme cases the experiences can be almost identical. This is made ever more true by the increase in terrorist attacks on civilian targets.

Unfortunately, there is also a growing body of research finding connections between stress and fibromyalgia (a chronic pain disorder).  In one study, for example, of the participants with PTSD, 45 percent had fibromaylgia and 65 percent had chronic pain (Hauser et al., 2013). Though it's too soon to make any solid conclusions, one could certainly argue the connection between stress and disease.

It is easy to see, therefore, why EMDR (Eye Movement Desensitization and Reprocessing) therapy found such great success so quickly. While the modality (type) of therapy matters little, a therapeutic focus on integrating the mind and the body is going to yield the best results.

Pixabay.com

Pixabay.com

Keeping in touch with how you are responding both psychologically as well as physiologically will go a long way in ensuring your flourishing mental health. There are many different ways to reconnect with your body. The body scan is one simple, but effective way. There are many sites that can outline these processes. Just choose the one that works for you.

In the meantime, a friendly challenge: Try to notice the first thing that happens when you grow upset. Where do you first feel frustration?

Actually, it is "What you say"...

In my short time counseling individuals, one aspect of the process has become glaringly clear to me; people have little insight into the impact of the language they use. This small, quite small, but very impactful tool that we have available to us can at once break us and mend us. We “talk” everyday; when we order a coffee; make a call to a client; seal that big deal; make a speech or a toast; radio in updates, benchmarks and bark orders.

As a first responder, you have used language to diffuse situations. You have used language to comfort families. You have used language to negotiate terms. You have also used language to report bad news, inform of a death or someone’s rights. We use language like we walk. We use language as a means to an end that get us from point A to point B. Usually, though not always, we use language to achieve a particular result that we want. And, incidentally, this occurs almost absent of our attention. A “slip of the tongue” should be evidence enough of this.

But, while we spend a lot of time projecting our voices out towards the world, we spend much more time narrating to ourselves. As I write this, for example, I can hear myself saying the words in my head. We are talking to ourselves constantly. Incidentally, we are talking to ourselves while talking to others. Remember that last time someone asked you a question and you couldn’t remember what was just said?

Language, then, is clearly important. But, more important is how you use that language. When people arrive for counseling majority of those clients have arrived because they are faced with an immovable barrier. They have tried on their own, but to no avail. They have come seeking answers to questions. Counsellors, work hard to reframe, retrain, re-inform, and rehabilitate these clients. There are a number of new therapies that are arising that focus on the mechanisms of the body (EMDR, is one), but talk therapy is most often what people receive. “Talk therapy”, is therapy using language, or simply the process of giving people new ways to “talk” to themselves!

How often have you found yourself saying things like, “I’m an idiot, I never should have…” If we’re being honest, we all have engaged in something like this. So, let us break apart this very small sentence.

First thing is what are we trying to say? Well, clearly we have fumbled on something. We may feel like “an idiot” but is there evidence to suggest that we are an idiot? What is an idiot? Is the term idiot a placeholder for an emotion that we are experiencing? Likely disappointment, embarrassment, shame, maybe regret or anger?  

So what….

The argument here is simply that if we spend a considerable amount of time berating ourselves, part of us bears that. This is usually our self-esteem and confidence. When this is depleted, what stores can we take from that will help us take risks and be comfortable making mistakes? If we are paying close attention, there is a hint of a growing anxiety that can take place as well. This is part of the seed that could grow into a larger issue.  

Instead, trying to identify what we are experiencing and confront that head on is a much more effective approach. Human behaviour is can largely be separated in two groups: the pursuit of pleasure and the avoidance of pain. From this point of view, obviously sitting with emotions is asking you to sit with pain. Yet, confronting these is the fastest, most efficient way to overcome them.

Be careful of the language that you use to yourself. This becomes more imperative when we begin to address mental health issues. It is counter productive to degrade ourselves when we need to take a close look at particularly difficult aspects of ourselves. Just reflect on whether you would hurl the same comments at a friend… and mean it.

On Killing and the Unintentional relationship with First Responders

Lt. Col. Dave Grossman wrote on the psychological effects killing had on soldiers. He
has spent an entire 300 plus pages dissecting with precision the reasons that soldiers did
not kill; the difference between killing at close range versus killing at a distance; the impact of each of the scenarios on the soldier’s psyche; and the ways to mitigate psychological stress on the solider following war.

There were several interesting overlaps between the experience of the solider and the
experience of the first responder.

Of interest, was Grossman’s (who is also a psychologist) explanation between distance of
the soldier and the intensity of trauma as a result. What Grossman found was that distance, both physically and psychologically, made a huge difference between whether a solider would shoot to kill, as well as whether they would be traumatized by the killing. 

Grossman went on to explore the various implementations that have gone into making the
soldier more detached, such as through adding mechanical means (scopes, night vision,thermal) as well as training differences.

As a first responder, our physical distance is very intimate. Police, Ems, and Fire all
grapple with people in a very intimate and vulnerable way. Though performing CPR may
be a “firefighter’s job” (as one paramedic friend once told me), it never did get easier for
me. There was something intimate about the process that makes one uncomfortable. Indeed, it also increases the feeling (at least for me) of some responsibility for this person. Were my compressions deep enough? Were they fast enough? Did the chest rise on the last two breaths? I’d pay particularly close attention to the EKG to measure compressions and keep a keen eye locked on whatever paramedic seemed to be closest.

As EMS is clearly tied into the above role, their role is obviously more involved. As well, the medical responsibility of their role ensures the necessity to cross this barrier into personal space. And police grapple with humans at their most violent and in their upmost crisis. They are much more likely to be the targets of violence and yet are still required to enter these private, close quarter spaces.

To illustrate these space-to-space dimensions that I mean, next time you are in line for a
coffee, pay attention to whether someone is standing too close to you. How close is “too close?” Where does your space begin? Or, if you’re brave, begin to invade on the person’s space in front of you. Do they shuffle forward? Do they say something? How many times have you pulled up behind someone in your car, only for them to inch forward just a bit?

After a lifetime of military services, Grossman was showing the resistance to killing on a continuum. But, much of what he discussed seemed quite parallel to the impact of this “issue of proximity” to the role of the first responder and the ensuing trauma or stress following a call. The DSM, the criteria for PTSD require the majority of events to have happened close to, or directly to the person (though they leave room, appropriately, for vicarious trauma). Proximity plays a key role.

This may seem obvious at first glance. Of course, the trauma statistics are much higher due to the exposure rates and the intensity of these exposures for the first responder. But, often it is believed that simply being a first responder is cause of a stress disorder. It is not simply the fact that if one is a Firefighter that they will succumb to a disorder. The stress comes from the fact that we lay actual hands upon the dying heart, pumping at a fast rate to trying to literally squeeze life back into a complete stranger. That connection can lead to emotional reactions that one neither plans nor wishes for. Of course, this is not Fire specific. The gravity of this role does not easily slide from the hands of paramedics or police either.

All of these recollections are fine, but what do we do with them. Perhaps another lesson can be learned from Grossman, who identified that one of the most beneficial processes was a “ritual cleansing”. These came in a lot of different forms, from parades to mandatory down time. Ultimately, the soldiers returning from war were receiving validation for what they did and saw.

To make this relative, Grossman identified that the vets from Vietnam did not have these ritualistic returns to civilian life; in fact, they were ostracized, belittled, and in some instances even assaulted. Grossman reflected that it was the vets from Vietnam that had the most psychological injuries (although, he conceded, that even more likely buried their problems and never came forward).

One potential ritual that departments can use is the informal “round table”. This is not structured like a diffusing or debriefing, however it allows the crew to talk about what happened and to gain support from their crewmates. Who ever leads these groups needs to ensure that blame and judgment never make it into these rituals. Lessons learned can come at a later date (especially if this call was a higher stress call). Create that safe place for reflection and validation. Let’s face it, not every call ends with a survivor. But, if a few people are starting to carry a bit of that weight, we owe it to them to remind them that they are not god. They can’t always save or bring someone back.

Creating your own rituals, whatever they may be, could be a great way to instill resilience
into your crew. As they grow to understand that following a call what ever they have decided comes next. Perhaps it’s a return to the hall, round table, and then washing of gear and placing it back in service. Whatever your ritual becomes make sure that it is acceptable by most and helps to validate and consolidate the experiences the crew just had.

In Defense of Families

In Defense of Families

When you are in desperate need of money and someone hands some to you, you would not exclaim, “That’s not enough”. But, for the purpose of this plea, that is what I am doing.

Today’s movement toward mental health in the lives of First Responders is amicable. We need something. And, furthering this push for aid the Ontario Association of Fire Chiefs has adopted a “fire” tailored program, the Road 2Mental Readiness (R2MR) from military fame, to fit the needs of the individuals in the fire service. Police have already had the program and are suggesting some success. It is rumored that EMS will, soon, also have their own program. Let’s hope that they continue this so we can include our bleeding friends in Corrections, Dispatch, and Emergency departments.  

These are all good things.

So, perhaps in light of this I sound a bit crass or callused, but hear (or rather, read) me out. These movements are good things; but, they are not enough. Not only are they insignificant given the level of mire we find ourselves in, they ignore possibly the single greatest preventative aspect of any First Responder; the family.

Why are we continuously suggesting that these issues and concerns are individualistic? At first, it was status quo to write off the few who spoke out around mental health issues as few “bad apples”, though this attitude certainly isn’t extinct. Fast forward to now, and we are acting to “… ensure that the most appropriate training is provided when required to ensure CAF personnel are prepared mentally for the challenges they may encounter.” (Taken from the Canadian Forces site: http://www.forces.gc.ca/en/caf-community-health-services-r2mr/index.page).

To be fair, there is a section dedicated to information for families. But the training is, essentially, for those entrenched. Our attitude has changed, but only for the individual.

Am I being nit-picky? Perhaps. But, when disaster strikes, a community corrals and comes together in a way that was unprecedented prior to the incident. So, we should adopt the same approach when disaster strikes an individual. A community is much better suited to deal with the multiplicity of issues that arise in a mental health crisis. Luckily, for many of us, we were born into a small community already; our family and friends.

Mental health is a Team approach. Walk into a mental health clinic today and you, more often than not (unless it is private), you will hear that “we are a team here at, so-and-so”. You’ll likely have signed consents that allow some of your information to be shared throughout the team to ensure continuity in services. From there, with your permission, you’re set-up with people from different organizations that specialize in the help you need.

But, in the mental health field it is recognized that marital issues, addictions, stress concerns,(or “enter other disorder here”) are not isolated issues. We do not live in a bubble. Mental health struggles are, more often than not, married to a co-occurring disorder (“concurrent”, in mental health babble). So, when you see an counsellor you are likely to be, or have already been, connected with a psychiatrist, or have a family doctor or registered nurse on board. Whatever the configuration, you have a team. Like-minded individuals all bolstering ethics that, though written differently, have ascribed to doing no harm and increasing good. Research has shown that this approach, sometimes falling under the name “biopsychosocial approach”, is garnering the greatest results.

Individuals in these new training developments are given all the tools that they need to help themselves from developing an issue, the tools to recognize the beginning of a problem, and perhaps a few resources to connect with if an issue finally does arise. And, there are training programs that help with the aftermath of “headliner” calls. Great! For a lot of people, that is going to save a lot of time, resources, heart-ache, self-doubt, self-harm, and even attempts at dying by suicide.

When they get home, however, we have not developed a “language” that can be shared between them and family members. They cannot talk about their experiences or the level of stress they are under. Moreover, First Responders are not very keen on talking about the gruesome details to their loved ones for fear of traumatizing them. Very valid and great reasoning for avoiding to explain said details; however, that is a very weak argument for not talking of the emotions felt around the situation.

We need to remember that we are not alone in these issues. PTSD is, arguably, one of the worst disorders that can strike a First Responder. Yet, PTSD is often occurring alongside addiction issues, marital issues, other mental health issues. If left unchecked, self-harm can become the only answer to the pain felt.

I have consoled family members, watched families say good-bye to loved ones, seen the concern of a parent when they have heard their child was in an accident. So have a lot of those reading this right now. I have watched families stand strong together as they stand idly, helplessly, as all their belongings perish in a fire. The shaking, the tears, the fear, the exasperation of people, are all images that anyone in this field has or will have eventually. Not all will stick with you, but some will. But, the more people corralled around during these times the better the outcome for that person.

Let us begin, then, to speak about the family members. They are also injured, hurting, and needing help. But, as we move forward, they seem to be only an echo behind the individual. Can we let them stand beside us, instead of behind us?

Nick.